The entire healthcare community has been abuzz this month about the Protecting Access to Medicare Act of 2014. In a move designed to avert the 24 percent pay cut your practice was due to face on April 1, Congress introduced this bill — but the resulting temporary fix also included an ICD-10 delay buried in the text.
Take a look at what you need to know to keep your practice up to date.
Check Out the ICD-10 Changes
Mentioned about one-third of the way into the 121-page bill is a short paragraph that states, “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets.” This means that since the bill has been signed into law, ICD-10 will be delayed for at least another year beyond the scheduled Oct. 1, 2014 implementation date.
Question: Does discussion time with family members count toward critical care?
Let these three answers guide your time-based E/M coding quandaries.
Pediatricians are masters at listening to worried parents, scared children, or other concerned caregivers. Those minutes spent talking to parents can be lengthy, but it isn’t wasted time since it assists you in diagnosing the patient and helps the patient understand his condition and how to get better. You can collect for that valuable time by utilizing time-based E/M coding to your advantage. Consider the answers to these commonly-asked questions to help you collect the appropriate payments for your evaluation and management visits.
‘Shall’ Doesn’t Mean ‘May’
Question 1: How do we know if we should code using time as the determining factor versus using history, exam, and medical decision-making? Our pediatrician sees a lot of kids with special needs and ostensibly we could be coding mostly 99215s if we coded them all based on time, but we aren’t sure when we should.
Brush up on the HPI and ROS components of history documentation to stay out of trouble.
One of the areas of documentation guidelines that can be most confusing to new coders is the overlap between the history of the present illness (HPI) and the review of systems (ROS). Brushing up on your rules about who can document what and from where these history elements can be drawn can save you lots of hassles. Read on for some expert “history” tips.
Who Can Record The HPI and ROS?
Patients suffering from recurrent dislocation of the shoulder have repeated partial or total separation of the head of humerus from the glenoid cavity.
Currently, you should report 718.31 (Recurrent dislocation of joint of shoulder region).
However, your options expand after October 1. You will have instead:
Question: We have a patient pregnant with twins whose BP readings at her second prenatal visit were very high. The physician wanted the patient to come in every two weeks for a simple nurse BP check to have her pressure monitored. Half of the readings were high and the others normal. Should I bill the insurance for the nurse’s visits done outside of her antepartum schedule?
Don’t default to 250.00 — follow these three crucial tips to find the right ICD-9 code.
With all of the talk about ICD-10 coding, it’s easy to fall behind in your ICD-9 skills. But if you want to keep collecting for your claims through the end of September, you should continue to hone your ICD-9 coding finesse. The following tips will help you code ophthalmic manifestations of diabetes so you can collect for all of your services.
1. Crack the Decimal Place Code
Hint: You don’t have to stay in your section of the book.
If you’ve ever wondered whether your general surgeon is limited to performing services from certain sections of CPT® or if other providers can venture into “your” territory, CPT® 2014 has the answers for you.
According to a new CPT® 2014 introduction,
Although the descriptor to acute laryngitis code doesn’t mention obstruction as in ICD-9, you still have to delve into patient documentation to check for this as you have two codes in ICD-10 for acute laryngitis based on the presence or absence of obstruction.
ICD-9: Diagnosis coding is simple in ICD-9 when your family physician diagnoses acute laryngitis. If no obstruction is present, you assign 464.00 (Acute laryngitis; without mention of obstruction). If an obstruction is present, you assign 464.01 (Acute laryngitis; with obstruction). Both codes apply to patients with several types of laryngitis:
- Edematous laryngitis
- Hemophilusinfluenzae laryngitis
- Pneumococcal laryngitis
- Septic laryngitis
- Suppurative laryngitis
- Ulcerative laryngitis
Question: Our surgeon stabilized a pilon fracture using an external fixator and operated to fix the fibular fracture. After two weeks, an internal fixation was done. Can we report both the external and internal fixation procedures for this patient?